血栓弹力图及传统凝血试验对肝移植术中用血的影响  

Effects of thromboelastogram,traditional coagulation test and condition on blood use in liver transplantation

作　　者：蒋波笛 孟祥红[1] 李瑞平 Jiang Bodi;Meng Xianghong;Li Ruiping(Department of Blood Transfusion Msdicine,8th Medicap Center of PLA General Hospital,Beijing 100091,China)

机构地区：[1]解放军总医院第八医学中心输血医学科,北京100091

出　　处：《实用器官移植电子杂志》2023年第5期441-446,共6页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：北京市科委首都临床特色专项课题(Z161100000516180)。

摘　　要：目的 通过肝移植术前血栓弹力图(thromboelastography,TEG)和常规凝血试验(conventional coagulation tests,CCTs)相关指标,分析检测指标对于肝移植术中用血的预测。方法 对2016年7至2021年12月解放军总医院第八医学中心肝胆外科22例行肝移植手术的患者,术前监测TEG及CCTs等指标,并对数据进行统计学分析。结果 肝移植以术中及术后输血为主,输注悬浮红细胞:冰冻血浆:血小板的比例为1:2.31:0.13。肝移植术中输注红细胞数量和输注血浆的数量与R、K、ANGLE、MA、PT、INR和APTT、HB和HCT具有线性关系。输注血小板数量与K、ANGLE、PT、INR、APTT及HCT具有线性关系。术前R、MA、HB、HCT可预测术中是否大量用血。TEG与CCTs具有一定的相关性。MELD评分> 10分组与MELD评分≤10分组比较,术中红细胞用量明显增加(P <0.05),K值明显延长(P <0.05),ANGLE角明显减小(P <0.05),MA值明显减小(P <0.01),具有统计学差异。结论 TEG和CCTs结合起来监测肝移植患者术前的凝血功能,对于肝移植术中用血具有一定指导意义,尤其对于肝移植患者术中大量用血的预测具有一定的临床意义。Objective The prediction of blood use during liver transplantation was analyzed by the relevant indexes of thromboelastography(TEG)and conventional coagulation tests(CCTs)before liver transplantation.Methods Twenty-two patients undergoing liver transplantation from July 2016 to December 2021,the Hepatobiliary Department of the Eighth Medical Center of the People's Liberation Army General Hospital were monitored for TEG and CCTs before operation,and the data were statistically analyzed.Results Blood transfusion was mainly used during and after liver transplantation.The ratio of suspended red blood cells to frozen plasma to platelets was 1:2.31:0.13.The number of red blood cells and plasma transfusion during liver transplantation had linear relationship with R,K,ANGLE,MA,PT,INR,APTT,HB and HCT.The number of platelets transfused had a linear relationship with K,ANGLE,PT,INR,APTT and HCT.Preoperative R value,MA,HB and HCT could predict whether a large amount of blood was used during operation.TEG had certain correlation with CCTs.Compared with the group with MELD score>10 and the group with MELD score≤10,the amount of red blood cells used during operation was significantly increased(P<0.05),the K value was significantly prolonged(P<0.05),the ANGLE angle was significantly decreased(P<0.05),and the MA value was significantly decreased(P<0.01),with statistical differences.Conclusion The combination of TEG and CCTs to monitor the coagulation function of liver transplant patients before operation has certain guiding significance for the blood use during liver transplantation,especially for the prediction of large amount of blood use during liver transplantation.

关 键 词：肝移植 输血 血栓弹力图 

分 类 号：R657.3[医药卫生—外科学]